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Otology: The anesthetic technique allows facial nerve monitoring, provides an immobile field with minimal blood loss and facilitates smooth emergence. Patients receive prophylaxis for postoperative nausea and dizziness. Nasal surgery and sleep disorder surgeries: Patients with sinus disease benefit from adequate analgesia and prophylaxis for postoperative nausea. Obstructive sleep apnea patients require assessment of secondary cardiopulmonary disease, evaluation for potential airway difficulty and appropriate postoperative monitoring. Endoscopic laser surgery: Prevention and management of airway fires, laser-safe endotracheal tubes and jet ventilation are distinctive aspects of anesthesia for laser surgery. Head and neck cancer with reconstruction: History, physical examination and radiographic studies determine the extent of airway distortion; further evaluation focuses on coexisting medical disease and effects of prior chemoradiation therapy. Initial airway management may require awake intubation or tracheostomy. Oral and maxillofacial surgery: Many cases require nasal intubation. Application of controlled hypotension for orthognathic surgeries decreases blood loss. Patients who have sustained trauma or have soft tissue infection present for emergency surgery. Workshop: The one-week airway management workshop integrates lectures, training in the airway laboratory and clinical assignments related to adult and pediatric difficult airway assessment and management. In small group sessions residents learn difficult airway management techniques such as fiberoptic intubation, retrograde intubation, cricothyroidotomy and jet ventilation as well as application of the lighted stylet, intubating LMA, Glidescope and other devices. Parwane Pagano, MD, Assistant Professor of Anesthesiology |
The rotation in otolaryngology/head and neck surgery offers experience in the anesthetic management of procedures in head and neck oncology, facial plastic and reconstructive surgery, laryngology, otology, sleep disorders and sinus disease. The patient population includes all ages and physical status classifications for both inpatient and outpatient surgery. Open communication between the anesthesiologist and surgeon is emphasized in preoperative airway assessment and shared access to the airway intraoperatively.